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Home My WebLink AboutBuilding Permit #90-11 - 12 GARDEN STREET 7/28/2010 BUILDING PER pORTliIT of z,�o gtio TOWN OF NORTH ANDOVER 32 bE`',•- _ =a °� F APPLICATION FOR PLAN EXAMINATION a, it e 4 Permit NO: Date Received q°gArea SSACHUS Date Issued: " IMPORTANT:Applicant must complete all items on this page iT CA _..- �- I Pnnt: PROPERJW: OWNER. P" MAP 210 041 • :PARCE-:4616- ZONING DISTRLCT Wistoric pistnct yes no ;Machine Shop Village yes. no JL TYPE OF IMPROVEMENT PROPOSED USE Residenti Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well -Floodplain Wetlands Watershed Dtstricf UVater/Se_'wer - - - - _ DESCRIPTION OF WORK TO E PREFORMED: : 41 lqezi Identification Please Type or Print Clearly) OWNER: Name:-dA**-S Phone: 9�� Address: / 6ard ed S7' Alo,-AA /�ekyt✓ .9- lli 8 7 5�S' LPc/! CONTRACTOR : Name._. G 1lIG/ ��•- s-/ Phone:,W Address: . - r' Slz ,/ i l�C �lzJ�"�l7zt Supervisor's Corisfcuctiora License'- s ..,:5d' 7 _ Exp. Date; r -•.__ i. z HDme Im rovement:License 9 R._ Exp. Date; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. C9C.7 Total Project Cost: $ S2/� �.�� FEE: $- Check No.: I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Snatue of AgentYOvvne _' _ _ Signature of contractor Location No. '+ Date 7-6;-2017ed i �aRTM TOWN OF NORTH ANDOVER NO 0ALn P `• ; ; Certificate of Occupancy $ cHus E<� Building/Frame Permit Fee $ CIO I s� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 41,L-d 2 3 D 6 Building Inspector f Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody Art Swimming Pools ` Well Tobacco Sales Food Packaging/Sales Private(septic tank,etc. Permanent Dumpster on Site I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY l INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH- ., Reviewed on Signature COMMENTS oning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: -'Located 384 Osgood Street FIRE DEPARTMENT Temp Dumpster on site, , yes no ' Located at 124,Main Street a I Frre Department signature/datewn - - E K.y . COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, -Siding, Interior Rehabilitation Permits I ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of K.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler p p Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application. ❑ Certified Proposed Plot Plan ❑ Photo of H.I.G..And C.S.L. Licenses - L3 Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2008 ORT#q 01" 0 f Andover 020 opt ze- 1 p �=+ LAKE O dover, 1VMass., I� COCMICHEWICK oRATED v BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System f. BUILDING INSPECTOR THIS CERTIFIES THAT ............. ) �'� e. ... ............................................. Foundation has permission to erect..............:......................... buildings on ..........1 .... M. .... ..R.................. Rough c to be occupied as........ .... ( '..... !fir .k , ....t........................................................................ ...... ...... himney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC STARTS Rough .. ...... . .... ... . ........ �....._...�..�..................... Service BUILDINC��N CTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT. Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. 07/28/2010 00:06 9786894425 PAGE 01 � w ruva�� rn 7/28/2010 ACORD t tllSi{Itl� 1 1 I'i'Rll/!f 1_j_ I I r r IS CVMFICATE t$18AUEP A3 A MATTER OF INFORMATION PRODUCER 0 LY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1'�y insurance AgeDC Inc., H L.DE% THIS CERTIFICATE DOES NOT AMEND,EXTEND OR nn 36 llaWthOmc AvcnuC A TZAR TH0 C_O_V_ERAGf:AFFORDED BY THE POLICIES BELOW. Methuen, m 01$44 n,, _... - C MPAIVIES AF�DING CGIVERA E co ANY Atlantic Charier insurance Commall- VDAC COMPANY INRUIfED David Brady B Custom Installations COMr- 31 NY 31 Crestwood Circle COMPANY Lawtenco,MA 0184 D TH)$IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HANE 85EN 185UED TO TMC INSURED NAMCD ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHETANDI G ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W141CH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED 9Y THE POUCIQs 000RISED HI MEIN IS SUDACT TO ALL THE TERMS, EXCLUSIONS AND CONDITION OF RUCH POLICIH3-LIMI114 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, rs CO TYPEOF 1NSURANCQ PAUCY NUMBER POLICY EFPI:rTV11 POLICY BXP1RAnDN I.I ag DATE(MM/DDfM DATE(MMm") (InThouermdnl DTA -- HODILY MJUNY OCC S Or-O ALUABLITY 60DILV INJURY ACG 9 COMrnEHENSIVE f01tM -- PROPr.MDAMAG60CC E PRFMIME61OPERATIONS FROPENSY IAMA019 AGG d UNDERCROUND 111APDOOMMNEDOCO b r,D(MOSION s COLLA012 H URD .�.. nM tin w. •M•.NMI^, ..•-•-- r pRGDUc*HCOMPLEIeDO f:R BI&PDCDMDINEDAGG PERSONAL INJURY AOO S �. CONTRACTUAL INDFPENDENT CONTRACT S 6'7 BROAO RORM PROPENIY D MAGE • PERSONAL INJURY 90DIlY INJURY AUTOMOBR.E LIA81UlY (Pat pntt3a^) 9 ANY AUTO BODILY INJUNY ALL OWNED AUTOS(PNvnle a") (Ver accldeBD 3 ALL OWMIM AUTOS -- - 10(harthan Plival^Pneeange PROPERTY DAMABiI! W wIRCD AUT08 pODILY INJURY 6 NON.OV Mt1nAU-ros PkOPERTYDAMAGE GARAGE LIASR.ITY COMBINED b ^— EACH OCOURRFNCE EXCE04 UARIUTY At~CRFCATQ 4 UMBRELLA PORM 5 OTHER THAN UMDnFLLA PC RM "" ,�( STATUTORY LIMIT) A eML ompp SA NAND WCV00528505 9/16/2009 9/16/201 _ EACH ACCIOFN7 S 100.000 The workers'COMpel ISation Olicy does not provide coverage for David Brndy. OISEASE-��N Fr,IPLldYI9M s 100,,000 OrtHER OM,AORIPnON OF OPERIMCIVS&DUMNI NENICLCBIDPECIAL ITAtngg 11 11 . ,,( �. LLQ {� 1;•.: •. �,.•1 !.i:j'`' 01 i �pulfefbdl rQli ccp�l6GI1 lIGI�,lW��Iri�'�I+'^,l�C..t'.�.. : .;,,I�a'sC SHOULD ANT or THE ABOVE DESGR►MFD POLICIES BG CANCCLLED BEFORE TN"- 'Town of North Andove ,MA EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Buildingnof Orth Andowicnt 12 UAY8 WRITTEN NotICE TO THE CERTr-IOATE HOLDER NAMFO TO THE LEFT, 1 Osgood De r BUT f AILURE TO MAIL SUCH NOTICES LL IMP08R NO OBLIGATION OR LIABILITY 1600b sgood S M� 1845 OF ANY)OND UPON THE COMPANY GENTS OR REPRE ATIVES. NortAUTHOaRLDREPRESENTAT" A + Z00/LOOz UNILIHA83OHn L09988tZL8 XV3 ZV:80 OLOZ/8Z/40 DATE[MM/Do/YY)GERTIFI'PAT ZOF; 7-26-10 WPOUCER --TRM—MFMF1ICATE- IS 1981090 A EA-0T-TRMWlarWoR ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hays Insurance Agency 'Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 36 Hawthorne A V e ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. M c C h u e n, Ma 01844 COMPANIES AFFORDING COVERAGE COMPANY A Norfolk: & Dedham Group PiSUPED COMPANY e COMPANY David Brady DBA Custom Installations C 31, Crestwood Circle —''"- -- - -~ - COMPANY L6LWrenCe, Ma 01843 p -4iS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD r1DICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS •.ERTIF(CATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT 70 ALL THE TERMS, c(",LUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, TYPE OF INSURANCE I POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATI0 L�AlIY6—— DATE(MM/DD/YY) DATE(MM/DD/'a) __ .______._.__ GENERAL LIABILITY GENERAL AGGREGATE S 6b(0,000 (:OMMERCIALGENERALLIABILIYY; R0403410A 9-13-09 9-13-10 PRODUCTS-COMP/OPAGG � S 600,000 CLAIMS MADE OCCUR PERSONAL 6 ADV INJURY S OWNER S 6 CONI'PFIOT EACH OCCURRENCE--- $ 30O,OOO FIRE DAMAGE(Any ono tiro( b --5,0-1-000 —MED-EXP(Any ono poryon) AUTOMOBILE LIABILITY ANY AUYp COMBINED SINGLE LIMIT S ALLOWNEDAUTOS i BODILY INJURY S SCHEDULED AUTOS i (Pur person) — .INEO AUT05 BODILY INJURY $ vON-OWNED AUTOS (Por ac4dunl) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY•EA ACCIDENT 1 E •'I''AUTO OTHER THAN AUTO ONLY I EACH ACCIDENT S j AGGREGATE S f►CESS LIABILITY I ( EACH OCCURRENCE I S ,+M6RELLA FORM I AGCREGATE S . ...-..._. . .... ._ .._....*........... THAN UMBRELLA FORM I S xOWKEAS COMPENSATION ANDI STATUTORY LIMITS EMPLOYERS'LIABILITY EACH ACCIDENT S I PROPRIETOR. INCL! DISEASE-POLICY LIMIT S I InFPS ARE EXCq DISEASE-EACH EMPLOYEE S OTHER — i i -,,AIPTIOKo}roFE-Rb�leNsl�cca7lDps�ve�rrctFsisaFciarlT�s Installation of kitchen cabinets and general residential carpentry :ERTIFICATE"WXXFA I• ;,'- CANCELLATION Town of North Andover, Ma SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Building Department 1600 Osgood Street 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OA LIABILITY North Andover, Na 01845 OC ANY KIND UPON TME COMPANY, ITS AGENTS OR REPRESENTATIVES. Ra171zp0 RtPA�3�►i'fATIVE '"'�"'—"""" '-ORO 25-S(3/93) r � O ACORD CORPORATION 1993 10 39dd 5ZVV6898L6 t£:£Z 0TOZ/LZ/L0 The Commonwealth of Alassachusetts Department .f o ,fnd ustr' lal_ �4ccid eats Office offnvestieations 600 Washington Street Boston, M14 02111 www-nzrzssgov/dia Workers' Compensation Insurance Affidavit: B�ders/Contractors/ElectriCianSlPlumb An Iicant Information ers _ Please Print Legibly Name (Business/Orgamzation/lndividual); (4) .:S1 Vires 0 . Address; C ., City/State/Zip: MleAC /f+' Pho Q Are you an employer?Check/the appropriate boa: 1.�I am a employer with 4. ❑ I am a general contractor and I Tie of project(req7:ed)employees(full and/orpart-time).* have hired the sub-contractors 6. ❑New construct 2•❑ I am a sole proprietor or partner- listed on the attached sheet 1 7• ❑Remodeling ship and have no-employees These subcontractors have working for me in any capacity. workers coin . ' 8' Q Demolition [No workers' comp. . P insurance. insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3.0 required] officers have exercised their 10 Q Electrical r I am a homeowner doing all work ria t of ex epi or additions exemption per MGL 11. Plumbing repairs or additions myself [No workers'comp. C. 152,§I(4);and we have no ❑ insurance.required.J t 12.[]Roof repairs employees. [No workers' �+ comp.insurance required.] 13 0 Other Ut that ch boy msst aso Cu cet the s ew7�„ 'I3ameowaers e4"- -hoY"^^i^; • who submit this affidavit indi^ 'a'or:mss'comp_`^.oc Y„Z; fou mag they 2_doh aL'wb:abc%thm:hire Outside conum--tor, submit a new affidavit indicating such. `Conitactors that clic kjc box h an eddItionai Sheet showing the name of the sub-eoniraetots and their workers'comp.aviicy isatininforati I ant an employer&&is providing workers'compensation surance or ou information. f my employees- Below is the policy and joh site Insurance Company Name:�lyL� �G Policy#or Self-ins.Lic.#: �� B / / Expiration Date: f . Job Site Address:A� 66r-o en 571-7Afoe4-Were .l City/State/Zip:�/'°4 044yew. Ww Attach a copY of the workers, compensation policy deca iaron.page(showing the policy number-and expiration date). Failure to secure coverage as required under Section 25A ofMGL c. 152 can lead to the imposition of criminal fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties of a of up to $250.00 a day against the violator. Be advised that a co Penalties m the foam of a STOP WORK ORDER and a fine Investigations of the DIA for insurance coverage verification PY of this statement maybe forwarded to the Office of Ido hereby certify er the pains and penalties aer fP jm7'th�zi the in provided above is a and correct Sinpatur Phone#: Official use only. Do not write in this area, to be completed by city or town officiaL Cita,or Town: PermitUcense# Issuing Authority(circle one): Z. Board of Health 2.Building.Department 3. City/Town 6. Other Tuns Clerk 4.Electrical Inspector 5.Plumbing e b p stop Contact Person: Phone'#: Information an_ d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their emnloyms. Pursuant to this statute,an employee is defined as"...every pt✓rson in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including t7ne legal representatives of a deceased employer, or tete receiver or trustee of an individual,partnership, association oY other legal entity,employing employees. However the owner of a dwelling house having not more than three aparta>tents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintemlince,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be cause of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Beal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to c ons&uct bindings in the commonwealth for any applicant who has not produced acceptable evidence of coimpliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the.performance of public work usz-E acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es) and phone mtmber(s)along with their certificate(s)of in�rance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'comp=sation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit should be Mt.'Ztm tri the city Or town th--,.the arplica ion for e^ths remit or license us being reques*.ed,not*.he of Industrial Accidents. Should you have.any questions*pgardit)L b the law, or if you=—-q'=,* ed to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insu=ce license member on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly, The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pemrit/license number which will be used as a reference number. In addition;an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary) and under`.`Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for futue panmit or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would bice to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and,famnumbez The CommonwealthL Gf Massachusetts. Department of Industrial Accidents Office of Inrestiaatioas 600 Washin2-7tun Street Boston,M-A 02111. Tel. # 617-72.7-4900 e3,ft406 or 1-977-TvL49S_AFE Revised 5-26-05 Fan: r 6.17-727-7749 tvrvm,.mass._°ov/dl8. 07/26/2010 06:35 9786894425 PAGE 01 AI.III.IIR - CER•TIF'ICAT�.:�4F��INS l �q'..'I1s.1: rEl„:';'"r'..Y,,I;,1�:r�,;''•!i''n, DATE IMMIDDJYV) -2V—l0 7 ;I �nOVCFQ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Hays Insurance Agency Inc HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 36 Hawthorne Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Methuen , Ma 01844 COMPANIES AFFORDING COVERAGE COMPANY A Norfolk & Dedham Group '�suRF,D .. .__ __.—..--•--.—_..----- COMPANY --... ...., . 8 David Brady DBA Custom Installations COMPANY 1367 Broadway _..... __._.__. Haverhill , ma 01832 COMPANY D COV M0 �. ,.y:, ! �!i '•1�7 J �YLI! Jam'. -J -MIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD NOICATED,NOTWITHSTANDING ANY RBOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS .;P.RTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, r(CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, .is ---.-(-_ --•---_----••--• POLICY EFFECTIVE POLICY EXPIRATION . a TYPE OP INSURANCE I POIJCY NUMBER DATE(MM/DD/YY) DATE(MM DDIYY) I LIMITS GENERAL LIABILITY ^ GENF,RAL AGGREGATE 0100T X COMMERCIAL GENERALLIABILITYi 804034, 10A9"13-09 9-13-10PA0DUCTS•C0MP;OPACiG j2- 600,000 CLAIMS MADE OCCUR PERSONAL&ADV INJURY S avINEa'S B CONT PgQT EACH OCCURRENCE S 3OO,6OO i FIRE DAMAGE(Any one life)- MED EXP(Any one Person) AUTOMOBILE LIABILITY• ANY AUTO COMBINED SINGLE LIMIT S , ALL OWNED AUTOS I BODILY INJURY SCHEDULED ALITQ$ (Pe(pornon) S -,QED AUTOS j BODILY INJURY — '!C)N•OWNED AUTOS (Por ncridenl) $ •..... PROPERTY DAMAGE 5 GARAGE LIABILITY AUTO ONLY•EA ACCIDENT f -N-1 AUTO OTHER THANAVTOONLY; - I EACH ACCIDENT S AGGREGATE��S E+CESS LIABILITY EACH OCCURRENCE ,IMBRELLAFORM _...._.__ _.. __......... AGGREGATE � g .Jr-ER THAN UMBRELLA FORM 5 NOQKERS COMPENSATION AND I STATUTORY1 ITS EMPLOYER$'LIABILITY EACH ACCIDENT S I ngOPRIETOR' INCL; DISEASE-POLICY LIMIT S _ au0AkA,FxECUTiv@ 1 .- --.._.-. ..._. . rI'-r:FQSAPE EXCL DI$EAeir-EACHE OYES 5 7TtirET7...------ i i i i �aIVTIONOFbPET7STION57Cb>uAllumvVECTAiTTfFI� installation of kitchen cabinets and general presidential carpentry :ERTIFICWT511 I CANCELLATION Town of North Andover, Ma SHOULD ANY OF THE AGOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL Building Department 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 1800 0ndoStreet A North Andover, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY er, Ma 01845 OF ANY KINO UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES. TYEDESbRTA11V .—.....•�.....-- .CORD 25-S(3/93) O ACORD CORPORATION 1993 .....-......... MA LIC NUMBER CS059757 HIC# 134639 "ADDING VALUE TO YOUR HOME" CUSTOM INSTALLATIONS A DA 111D BRADY CO 31 Crestwood Circle Lawrence, MA 978 689 0681 -P 978 689 0682-F SPECIFICATION WORKSHEET/ CONTRACT CUSTOMER NAME CUSTOMER PHONE { Charles Gignac 978 609 7812 ADDRESS: ZIP CODE: 12 Garden Street 01845 CITY: STATE: North Andover Ma. PROVISIONS: PLANS&PERMITS:ALL APPROPRIATE PERMITS SHALL BE THE RESPONSIBILTY OF Custom Installations,ALL WORK SHALL BE DONE IN ACCORDANCE WITH LOCAL AND STATE BUILDING CODE.A DETAILED SET OF BUILDING PLANS SHALL BE PROVIDED, PLANS SHALL CONSIST OF ELEVATION,CROSS SECTIONS,FLOOR PLANS,AND ANY OTHER DOCUMENTATION DEEMED NECESSARY BY BUILDING OFFICIAL TO OBTAIN PROPER BUILDING PERMITS.IF PLANS REQUIRE A CERTIFIED ENGINEERS STAMP,THIS COST WILL BE THE RESPONSIBILITY OF HOMEOWNER.SUPPLY OF APPROPRIATE BUILDING PLANS SHALL BE REPONSIBILITY OF Homeowner. OBTAINING PERMITS,AND PAYING PERMIT FEES SHALL BE RESPONSIBILITY OF Custom Installations.ABSOLUTELY NO WORK WILL BE DONE WITHOUT THE PROPER BUILDING PERMITS.THIS INCLUDES,BUT IS NOT LIMITED TO,ANY AND ALL DEMOLITION WORK,UNLESS APPROVED BY LOCAL BUILDING OFFICIAL. UNFORSEEN CIRCUMSTAMCE:GREAT CARE HAS BEEN TAKEN TO PROVIDE ACCURATE PRICING.HOWEVER,IN THE EVENT THAT"UNFORSEEN CIRCUMSTANCES"ARISE THAT ARE BEYOND THE CONTRACTOR'S CONTROL,ADDITIONAL COSTS MAY BE INCURRED BY HOME OWNER.IN THE EVEN OF"UNFORSEEN CIRCUMSTANCES",A WRITTEM ADDENDUM TO CONTRACT SHALL BE PROVIDED BY CONTRACTOR AND SIGNED BY ALL PARTIES BEFORE CONTINUING WITH THAT PARTICULAR ASPECT OF PROJECT. "UNFORSEEN CIRCUMSTANCES"CAN CONSIST OF,BUT NOT BE LIMITED TO,STRUCTURAL DEFECTS THAT ARE HIDDEN BY SHEATHING, CERTAIN GROUND CONDITIONS BENEATH GRADE. DEBRIS REMOVAL: ALL DEBRIS REMOVAL SHALL BE THE RESPONSIBILITY OF Custom Installations.IF CONTRACTOR IS RESPONSIBLE FOR DEBRIS REMOVAL,A DUMSPSTER OR SIMILAR SHALL BE PROVIDED.FURTHERMORE,JOB SITE WILL BE KEPT IN A SAFE,PROFESSIONAL,AND WORKMAN-LIKE MANNER. CONSTRRUCTION PRACTICES:ALL WORK TO BE PERFORMED IN A PROFESSIONAL AND WORKMAN-LIKE MANNER AND BE DONE IN ACCORDANCE WITH ALL LOCAL AND STATE BUILDING CODES,AND TO CONFORM TO PLANS AND SPECIFICATIONS PROVIDED.ALL WORK TO BE DONE WITH GENERALLY ACCEPTED CONSTRUCTION PRACTICES. SCOPE OF PROJECT: Demo: Existing vanity cabinet.Existing trim @ window,door and base molding. Existing tile within tub and which is applied to walls. Existing vinyl flooring down to sub floor. Existing gypsum wall board down to framing within bath area. Existing 5x12 gypsum ceiling @ hall area. Existing sink. Existing faucet. Existing counter top. Existing toilet. Existing tub. Debris removal: All construction debris to be placed in a contractor provided container and hauled away. Carpenter/drywall: Furnish and install pine trim required to separate hall from adjacent room. Furnish and install materials required for opening to accommodate recessed medicine cabinet. Furnish and install batt style fiberglass insulation at exterior wall and within ceiling(all insulated areas to have continuous vapor barrier). Furnish and install all fire stopping at floor and ceiling penetrations. Furnish and install materials required to vent fan/light combo to exterior of home. Furnish and install ''/2"blue board with skim coat plaster at walls and ceiling within bathroom area(walls to be finished smooth ceiling to be textured). Furnish and install ''/z"blue board with skim coat plaster at ceiling in front hall(ceiling to match existing). Furnish and install 2 '/z"colonial casing at window and door within bathroom. Furnish and install 3 '/z"colonial base molding at floor within bathroom area. Furnish and install recessed medicine cabinet above vanity. Furnish and install materials required for pine shelving unit over toilet. Furnish and install toilet paper holder(1). Furnish and install towel bars(2).Furnish and install vanity cabinet. Furnish and install counter top. Plumbing: Furnish and install toilet. Furnish and install sink. Furnish and install faucet. Furnish and install (4) piece fiberglass tub unit. Furnish and install materials required to re work trap assembly within vanity cabinet. Furnish and install materials required to re work water piping within hall ceiling. Furnish and install materials required to re work trap assembly at tub. Furnish and install shut off valves within vanity cabinet. Electric: Furnish and install 20 amp dedicated circuit within bathroom area. Furnish and install fan/light combo at ceiling within bathroom area. Furnish and install light above vanity. Flooring: Furnish and install '/4"cement backer board at sub floor. Furnish and install mortar,the and grout within bathroom floor area. Paint: Furnish and install(1)coat primer/sealer to all new plaster walls and ceilings. Furnish and install(2)coats flat paint at new walls and ceilings. Furnish and install(2)coats semi-gloss paint at all new trim areas. Permits: All permits including building, wiring and plumbing to be obtained and paid for by contractor and appropriate sub contractors. Fixtures: All fixtures have been chosen and approved of by owner.(includes vanity cabinet and top) MATERIALS:ALL MATERIALS WILL CONFORM TO LOCAL AND STATE BUILDING CODES AND WILL BE AS SPECIFIED IN DRAWINGS PROVIDED AND APPROVED BY LOCAL BUILDING OFFICIAL. RIGHT OF DISPUTE:IN THE EVENT OF DISPUTE BETWEEN HOMEOWNER AND CONTRACTOR,TERMS OF THIS SPEC.SHEET WILL TAKE PRECEDENT OVER ANY AND ALL OTHER FORMS OF DOCUMENTATION.THE CONTRACTOR AND HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THE CONTRACTOR HAS A DISPUTE CONCERNING THIS CONTRACT,THE CONTRACTOR MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMITR SUCH ARBITRATION AS PROVIDED IN MGL.c. 142A. .....................................OWNER ....................................CONTRACTOR NOTICE:THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES ALTERNATE DISPUTE RESOLUTION INITIATED BY THE CONTRACTOR.THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SIGNED SEPARATELY BY THE PARTIES. PAYMENT TERMS: TERMS OF PAYMENT ARE AS FOLLOWS: Total cost of this contract to be$21750.00 and be paid in (3) installments 1) 1/3`1 in advance 4 $7250.00 2) 1/3`d upon completion of rough in $7250.00 3) 1/3`d upon completion of work $7250.00 LEGAL:ALL HOME IMPROVEMENT CONTRACTORS AND SUB CONTRACTORS SHALL BE REGISTERED AS A HOME INPROVEMENT CONTRACTOR WITH THE STATE OF MASSACHUSETTS,ANY INQUIRIES ABOUT A CONTRACTOR OR SUB CONTRACTOR RELATING TO AREGISTRATION SHOULD BE DIRECTED TO: DIRECTOR,HOME.INPROVIMENT CONTRACTOR REGISTRATION PROGRAM, P.O.BOX 871,TAUNTON,MA 02780-0871 PHONE:(508)821-9375 HOMEOWNER HAS RIGHT TO CANCEL THIS CONTRACT WITHIN THREE BUSINESS DAYS OF SIGNING DATE WARRANTY OF ALL MATERIAL SHALL BE THE RESPONSIBILITY OF THAT MATERIAL MANUFACTURER AND NOT THE CONTRACTOE,THE CONTRACTOR WILL WARRANTY ALL INSTALLATION OF PRODUCT AND CONSTRUCTION PRACTICES FOR A PERIOD OF ONE(I)YEAR FROM THE DATE OF INSTALLATION.CONTRACTOR SHALL ALSO POSSESS AND PRODUCE IF REQUESTED A CURRENT MASSACHUSETTS CONSTRUCTION. SUPERVISORS LICENSE INQUIRIES MAY BE MADE BY CONTRACTING BOARD OF BUILDING REGULATIONS AND STANDARDS ONE ASHBURTON PLACE BOSTON,MA 02108 PHONE:(617)727-3200 EXT 607 ONLINE:www.mass.gov/bbrs/csiscarch.litni ACCEPTANCE OF TERMS:BY SIGNING BELOW,HOME OWNER AND CONTRACTOR AGREE TO SPECIFIACTAIONS AS LAID OUT WITHIN THIS SPEC.SHEET.ALSO,BY SIGING,THIS WILL BECOME A BINDING LEGAL CONTRACT. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CUSTOMER SIGNATURE CONTARCTIOR SIGNATURE DAVID J. BRADY A............ ....�........ ............... .... ................ aLlll(DATED: 7/19/2010 Approximate start date 7/26/2010 Approximate complete date 8/30/2010 LZ ' Ll I I -'�- �Iassachusctts- Dcpat•trncnt of Public Safct� BOMA of Buildinu, Regulations and'Standards i Construction Supervisor p License { 6 License: CS 59757 Restricted to: 00 DAVID J BRADY 31 CRESTWOOD CIR LAWRENCE, MA 01843 Expiration: 1/28/2012 ('onnnissi1O/'' Tr#: 16810 N. Varivnzareuiea� o��/�(�acliuGell6 d Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR + Registration_`. 34639 I Expiratr- 072011 Tr# 291415 -�___ Type'jt�ndividuaf �� — rl DAVID J.BRADYi �� w; DAVID BRADY 0e_ 31 CRESTWOODIRCL1 r, LAWRENCE,MA 01843 Undersecretary